Warren Buffet once said that the difference between a conversation and commitment is a cheque. There’s certainly something in this. If you believe in something you should pay for it, right? So, if one in four walk-in centres are closing, that would suggest that this is because the NHS doesn’t value them sufficiently to keep them open. The NHS isn’t willing to pay for them, ergo, then don’t have value.
But this logic only works if all funding decisions are made rationally. There are at least two reasons why this isn’t the case with the walk-in centres. First, because it seems that many people are waiting longer than want to (or sometimes should be waiting), to get a GP appointment. I don’t have a problem getting a GP appointment in a reasonable time, but understand this isn’t always the case for others, especially those in big cities. If the walk-in centres are providing extra needed capacity, then it would suggest that closing them isn’t right – especially if, as Monitor report, the people using them will end up in A&E instead. That isn’t going to help anyone, and is going to cost a lot of money. We have been told that the walk-in centres are ‘popular’ in press coverage this morning, but I haven’t seen good research examining whether their case-load is made up of non-urgent cases, or whether they are providing a valuable additional service. It seems we don’t really know enough about walk-in centres actually do, and that is half the problem.
A second problem with the idea that, if walk-in centres were useful, then the NHS would pay for them, is that is assumes a market-based rationality. It assumes that patient need and patient choice is driving the system, and I’d be amazed if that were the case. We have been told that the walk-in centres are ‘popular’ as I mentioned above – in which case they should be getting the funding they need, and it seems this isn’t the case. And even if the walk-in centres were popular, that still doesn’t mean they are actually serving a clear health need – we ought to be asking deeper questions as to why people who go in them aren’t visiting their GPs – whether they can’t be bothered to book an appointment, or can’t get one. Whether they actually need to see a doctor, or their needs could be better met through seeing someone else (or perhaps even, no-one at all). Healthcare isn’t a consumer good, as individual patients are usually not in the position to know if the person seeing them knows what they are talking about or not.
So closing the walk-in centres may or may not be a good thing in terms of providing better care. It may be that CCGs don’t want to pay for them because their members aren’t working in walk-in centres. It may be that commissioners don’t have the research to show whether walk-in centres are valuable or not. It may be that we’d all make greater use of walk-in centres if they were more convenient to get to than their own GPs – especially for us commuters.
What the closures do show, however, is the deep irrationality of the purchaser-provider split. If the NHS needs the extra service and capacity that the walk-in centres offer, it should be making the funding available. This shouldn’t be about the localised purchasing decisions of CCG, which seem to be largely unaccountable and unjustifiable here, as these decisions don’t appear to be being based on any particular evidence.